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Dedicated to Neck & Back Pain Management.
 

What is DISC PROLAPSE / SLIPPED DISC / RUPTURED / TORN DISC / DISC HERNIATION ?
 

Back and neck Pain is the price human beings pay for poor posture, prolonged sitting, repeated bending, and other stresses placed on the lower back and neck. . Disks are soft, rubbery pads, which act as shock absorbers between the hard bones (vertebrae) of the spinal column. The disks between the vertebrae allow the back to flex or bend.

Disks in the lumbar spine (low back) are composed of a thick outer ring of cartilage (annulus) and an inner gel-like substance (nucleus). In the cervical spine (neck), the disks are similar but smaller in size. A helpful comparison is a jelly donut: its thick outer portion represents the annulus, while the jelly is similar to the nucleus.

The annulus can become stressed and with time, small tears can form in the annulus. This outer ring normally keeps the soft, gel-like center of the disc contained. The gel center, known as the nucleus, can be ejected from the disc through an annular tear. This is called a disc herniation. Protrusion of the nucleus posteriorly causes pressure over the nerve roots, spinal cord & other internal contents, which is responsible for pain in the limbs, motor & sensory deficit.


           NORMAL DISC ANATOMY                      HERNIATED DISC



WHAT KIND OF PROBLEMS DOES THE PATIENT SUFFER FROM?

Upon compression of the spinal nerve, three things can occur individually or together:
1. Pain where the nerve is compressed.
2. Pain will begin radiating along the path of the compressed nerve, down the buttocks and hips into the legs - Sciatica or into the upper limb in case of cervical spine.
3. Whatever the compressed nerve is controlling will begin to malfunction. Numbness and tingling in the feet or loss of strength in the legs and hands. Left untreated, this can lead to a lifetime of suffering and even paralysis.

SCIATICA is a pain that radiates from your back to buttocks and down the legs to the feet. For patients with this condition, forward movements of the spine, posture, coughing, sneezing, and all movement can influence pain coming from the spine. Patients may experience numbness, tingling, burning, or a pins-and-needles type sensation in the legs.

STAGES OF DISC HERNIATION
1) Disc Degeneration: chemical changes associated with aging causes discs to weaken, but without a herniation.
 
2) Prolapse: the form or position of the disc changes with some slight impingement into the spinal canal. Also called a bulge or protrusion.

3) Extrusion: the gel-like nucleus pulposes breaks through the tire-like wall (annulus fibrosus) but remains within the disc.

4) Sequestration or Sequestered Disc: the nucleus pulposus breaks through the annulus fibrosus and lies outside the disc in the spinal canal (HNP).

Risk Factors/Prevention
As people age, the water content in the disks decreases, they shrink and become less flexible. Conditions that can weaken the disk include:
• Improper lifting
• Smoking
• Excessive body weight that places added stress on the disks (in the lower back)
• Sudden pressure (which may be slight)
• Repetitive strenuous activities

DIAGNOSIS
Complete history and detailed physical examination
X-ray of neck or back
MRI
CT-myleography
Discogram
Nerve studies

TREATMENT
Depending on the results of the physical examination and the severity of your condition, your doctor may offer you two forms of treatment.

CONSERVATIVE TREATMENT
Most neck or back pain will resolve gradually with simple measures. More than one-half of patients who initially present with low back pain recover within 1 week and more than 90% of patients recover in 3 months. Physical therapy is started as tolerated.
• Absolute bed rest is recommended for 1 to 2 days with small pillow supports under the knees and neck to minimize root tension. Prolonged bed rest is not advocated.
• Muscle relaxants, analgesic and anti-inflammatory medications are also helpful.
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Pain relievers
• Muscle relaxants
• Spinal injections (anesthetics, corticosteroids)
• Antidepressants
• Sleep aids
• You can also apply cold compresses or ice for no more than 20 minutes at a time, several times a day.
• After any spasms settle, you can switch to gentle heat applications.
 
Any physical activity should be slow and controlled, especially bending forward and lifting. This can help ensure that symptoms do not return. Take short walks and avoid sitting for long periods. For the lower back, exercises may also be helpful in strengthening back and abdominal muscles. For the neck, exercises or traction may also be helpful. It's essential that you learn how to properly stand, sit and lift. This can help you avoid future episodes of pain.

SURGICAL TREATMENT
If a patient fails to improve within 6 weeks of intensive conservative care, a further work-up is warranted. In patients with predominant back pain, bone scan and medical work-up to rule out spinal tumors, infection, and non-spinal etiologies of pain are justified. If these studies are negative, back rehabilitation is continued. In patients who predominantly have leg pain and fail conservative modalities, a trial of epidural steroids or selective nerve root injections may be effective.
Surgery may be required if a disk fragment lodges in the spinal canal and presses on a nerve, causing significant loss of function. Surgical options in the lower back include microdisectomy or laminectomy depending on the size and position of the disk herniation. In the neck, an anterior cervical discectomy and fusion is usually recommended. This involves removing the entire disk to take the pressure off the spinal cord and nerve roots. Bone is placed in the disc space and a metal plate may be used to stabilize the spine.

INDICATIONS FOR SURGERY
• Recurring buttock, groin, low back, or leg pain, numbness or weakness
• Pain that has not responded to conservative treatments, i.e. bed rest, pain medication, physical therapy, or muscle relaxants and traction
• There has been increase in pain, numbness and weakness with patient on conservative treatments; Cauda equina syndrome– loss of bowel & bladder control
• Herniated disc confirmed on CT scan, MRI scan, Enhanced CT scan, Myleography, or Discography

What is new?
Presently Spine specialists all over the world are practicing Minimal Invasive techniques to treat these problems. The MIS techniques can be accomplished with a smaller incision, shorter hospital stay and early return to work. It may be performed as an outpatient or require an overnight hospital stay. Spinal Arthoplasty- Cervical and Lumbar Disc Replacement is also gaining popularity as a treatment option for HNP.

How we do it?
Go to Endoscopic Discectomy

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